Stephen Crowley/The
New York TimesThe Supreme Court
building early Thursday.

“This is great news for
seniors on Medicare,” Paul Nathanson, executive director
of the National Senior Citizens Law Center, a nonprofit
advocacy group, said in a conference call on Thursday
after the Supreme Court issued its ruling upholding the
Affordable Care Act.

Because several key provisions involving Medicare kicked
in soon after Congress passed the bill in 2010, many
beneficiaries won’t see big changes in their coverage
now. But those improvements could have evaporated had
the law been overturned, so the ruling generated sighs
of relief among advocacy organizations for older adults.

This means the annual free wellness exam will continue
(about 2.2 million people took advantage of it last
year, according to AARP), along with the first “Welcome
to Medicare” visit, which will remain free, with no
out-of-pocket costs.

A number of preventive services, including mammograms,
bone scans and depression and diabetes screenings, used
to involve deductibles and co-pays; under the Affordable
Care Act, they no longer do.

And the gradual closing of the dread “doughnut hole” gap
in Part D drug coverage by 2020 will proceed, bolstered
by discounts that have already lowered drug costs. “The
average Medicare beneficiary will continue to save an
average $650 a year,” Max Richtman, who leads the
National Committee to Preserve Social Security and
Medicare, said in Thursday’s teleconference. “That’s
real money, especially for seniors.”

On the long-term care front, the court’s action
preserves several initiatives advancing efforts to
support elderly and disabled people in their homes,
rather than in nursing homes.

Several are already under way, including the Community
First Choice Option, which assists states with the costs
of in-home programs for people who would otherwise be
institutionalized, and the Balancing Incentive Program,
which increases federal matching Medicaid funds in
states with less coverage for home and community
services.

And starting in 2014, the Affordable Care Act will help
husbands and wives hold onto more of their assets if a
spouse must spend down to qualify for Medicaid.

Provisions that strengthen efforts to cut Medicare abuse
and fraud will survive as well. And if the economics
work as the Obama administration planned — a fairly big
if — Medicare as a whole stays solvent longer.

One murky question concerns Medicaid, and the court’s
ruling that states that don’t agree to expand their
coverage can’t be penalized by losing their current
financing. This could affect millions of people, but
“we’re not exactly sure of all the ramifications,” Mr.
Nathanson acknowledged.

Many states might agree to the expansion anyway, said
Kevin Prindiville, deputy director of the National
Senior Citizens Law Center. “The states get a great
deal,” he said. “The feds pick up most of the costs.”

Amid the general applause from advocates for the
elderly, several leaders said they foresaw ongoing
Medicaid tussles with Congress and state governments.
But for now, they were all smiles.

“A great win,” Mr. Prindiville said. “The act is going
to improve health for seniors in a variety of ways.”